Washing Of Gloves Research Articles

Cytopathologic assessment of gloves and instruments after major head and neck surgery

PurposeTo investigate the potential for cancer cells to be transferred between anatomic sites via instruments and other materials. Materials and methodsPilot prospective study from April 2018–January 2019 at Rush University Medical Center. Glove and instrument washings were collected from 18 high-risk head and neck cancer resection cases (36 samples total). Each case maintained at least one of the following features in addition to a diagnosis of squamous cell carcinoma or sarcoma: palliative/salvage surgery, positive margins, extensive tumor burden, and/or extra capsular extension (ECE). Surgical gloves and four main instruments were placed through washings for blind cytological assessment (2 samples/case). Results18 patients undergoing surgical tumor resection for biopsy-proven squamous cell carcinoma with at least one of the aforementioned characteristics were included. 26.7% of cases had ECE, 40.0% had positive final margins and 46.7% had close final margins. Tumor locations included: oral cavity (10), neck (4), parotid gland (2), and skin (2). Malignant cells were isolated on glove washings in 1 case (5.5%). No malignant cells were isolated from instrument washings. The single case of malignant cells on glove washings occurred in a recurrent, invasive squamous cell carcinoma of the scalp with intracranial extension. Anucleated squamous cells likely from surgeon skin were isolated from 94.4% of washings. Squamous cells were differentiated from mature cells by the absence of nuclei. ConclusionsMalignant squamous cells can be isolated from surgical glove washings, supporting the practice of changing of gloves after gross tumor resection during major head and neck cancer resections.

Abstract B37: Cytopathologic assessment of gloves and instruments after major head and neck surgery: Implications for intraoperative practices

Abstract Introduction: The purpose of the present study was to investigate the potential for cancer cells to be transferred between anatomic sites via instruments and other materials, promoting the dissemination of cancerous cells from existing tumors to previously unaffected regions of the body. Methods: Pilot prospective study over a 6-month period (April-August 2018) at Rush University Medical Center of glove and instrument washings from 15 high-risk head and neck cancer resection cases (30 samples total). Each case maintained at least one of the following features in addition to a biopsy-proven diagnosis of squamous cell carcinoma or sarcoma of the head and neck: palliative surgery or salvage surgery, positive initial or final margins, extensive tumor burden, and/or extracapsular extension (ECE). After completion of each ablative procedure, surgical gloves of the primary surgeon and the four main surgical instruments in direct contact with the tumor were placed through washings for cytologic assessment (2 samples per case). Tumor and case characteristics were recorded. Samples were blindly evaluated by a board-certified cytopathologist for cytologic assessment. Results: 15 patients (11 males, 4 females, average age 65.13 years) undergoing surgical tumor resection for biopsy-proven squamous cell carcinoma with at least one of the aforementioned additional characteristics were included in the study. 26.7% of cases had ECE, 40.0% of cases had positive final margins, and 46.7% of cases had close final margins. Resected tumor locations included the oral cavity (7 cases), neck (4 cases), parotid gland (2 cases), and skin (2 cases). Malignant cells were isolated on glove washings in 1 case (6.7% of cases). No malignant cells were isolated from instrument washings. The single case of malignant cells on glove washings occurred in a recurrent, invasive squamous cell carcinoma of the scalp with intracranial extension. Anucleated squamous cells likely from surgeon skin contamination were isolated from 93.3% of instrument washings and 93.3% of glove washings. These squamous cells were differentiated from mature cells of the oral cavity by the absence of nuclei. Conclusions: Malignant squamous cells can be isolated from surgical glove washings. This supports the common practice of changing gloves during major head and neck cancer resections and may have important implications for intraoperative practices. Additional investigation is needed to assess for viability of detected malignant cells. Citation Format: Hannah N. Kuhar, Aryan Shay, Peter C. Revenaugh, Kerstin Stenson, Bobby Tajudeen, Paolo Gattuso, Samer Al-Khudari. Cytopathologic assessment of gloves and instruments after major head and neck surgery: Implications for intraoperative practices [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B37.

Efficacy of chlorine as a disinfecting agent on produce-harvesting gloves contaminated with Escherichia coli O157:H7 or Salmonella

To minimize pathogen transfer from field worker's hands during hand harvest of ready-to-eat produce, gloves are often worn. However, fields are not sterile environments and transfer of pathogens to the gloves could occur throughout the day if the gloves come into contact with contaminated materials such as soil and produce. Given that changing gloves repeatedly is a costly solution, the merits to disinfecting gloves with chlorine solutions in the field were explored with efficacy (percent prevalence of gloves that were negative or positive for the pathogen) evaluated by subjecting the treated gloves to enrichment culture. Both the glove's level of pathogen contamination and chlorine exposure concentration affected the efficacy (P = 0.0000 and 0.0025, respectively). For example, complete elimination of Salmonella inoculated at ca. 3 log CFU/nitrile glove piece occurred at 50 ppm chlorine. However, when glove pieces had initial levels of ca. 6 log CFU E. coli O157:H7, exposure to 175 ppm did not completely eliminate the pathogen. Moreover, the likelihood of E. coli O157:H7 and Salmonella surviving were 32.0 and 4.4 times greater when the pathogen had been cultured on solid agar versus in liquid broth (95% CIs: 10.9 to 94.3 [P = 0.0000] and 2.1 to 8.9 [P = 0.0000], respectively). Another observation of this study was that dirty gloves exposed to both soil and lettuce sap were 11.6 times more likely than clean gloves to have the pathogen present after chlorine treatment (95% CI: 3.4 to 39.2, P = 0.0000). Monitoring these wash solutions for active chlorine revealed that no more than a 50% drop occurred suggesting that sufficient active chlorine remained for inactivating suspended pathogens and preventing cross-contamination. This data together with the observation that washing gloves in a second fresh batch of chlorine had little effect on the number of gloves absent of contamination would suggest that soil and sap is likely serving to protect the pathogen from exposure to the chlorine disinfectant. In an attempt to remove these materials, scrubbing during the chlorine immersion did not affect the efficacy of contaminated nitrile gloves (P = 0.1054) and actually led to a decreased efficacy of the chlorine treatment on contaminated Canners gloves (P = 0.0308). Although Salmonella and E. coli O157:H7 residing on nitrile and Canners gloves that survived exposure to 200 ppm chlorine could be transferred to produce handled by the treated gloves, frequent washing of gloves with chlorine could be an effective risk reduction strategy as they would reduce the numbers of gloves that may be contaminated with low levels of pathogens.

Evaluation of glove integrity after multiple washes with disinfectant

Background: In an academic setting due to financial constrain, it is not uncommon during non-surgical procedures dental students and clinical supervisors wash their gloved hands with disinfectants in between patients or when touching on non-contaminated objects. Whether this practice could cause any deterioration of the glove and expose clinicians and patients to infectious micro-organisms was a concern. Aim: The aim of this study was to investigate the effect of multiple washes of gloved hands with a disinfectant on the integrity of the gloves. Methods: Three brands of commonly used gloves in a dental school were tested for leaks after multiple washes with a disinfectant. Thirty pairs of each type of gloves were subjected to 0, 1, 5, 10, 20 and 30 washes with a disinfectant solution at a 5-minute interval between each wash. After each washing cycle, the gloves were filled with 1L of water and hanged for 2 minutes to observe any signs of water leaks. Results: The results showed that the type of gloves and number of washes were significantly associated with the leakage rates (p<0.001). Washing of gloves for more than 5 times were at least 6 times higher to suffer from leakage (OR=6.23, 95% CI=2.14–18.08). Powdered gloves were almost 13 times higher to leak in all washes (OR=12.78, 95% CI= 4.40–37.14) and were almost 25 times more likely to leak when washed for more than 5 times (OR = 24.92, 95% CI = 5.79 – 107.21) when compared to the non-powdered gloves. Conclusion: The practice of washing gloved hands with a disinfectant deteriorates the integrity of the gloves.

The effect of blood on disinfection of surgeons' hands.

Abstract The effect on skin flora of spreading 2 ml of blood over the hands after a 2-minute disinfectant handwash and then wearing rubber gloves for an hour was assessed by a trial in which 6 volunteers used each of six preparations, once with blood and once, as a control experiment, with water on their hands. Bacterial counts of handwashings and of glove washings showed significant interference by blood with the effectiveness of povidone iodine detergent solution (Disadine). With a 3 per cent hexachlorophane detergent cream (Disfex) significant interference by blood was shown in bacterial counts of glove washings and a nearly significant interference was shown in counts of handwashings. There was no evidence of any interference by blood with the effectiveness of a 4 per cent chlorhexidine detergent solution (Hibiscrub) or a 3 per cent hexachlorophane liquid soap containing 0.3 per cent chlorocresol (Ster-Zac).

Examination gloves affect secretion of matrix metalloproteinases and their inhibitors from human abdominal skin fibroblasts.

Overexpression of matrix metalloproteinases (MMPs) has been observed in chronic, compared to acute, wounds and altered levels might impair healing. During treatment of wounds, examination gloves are routinely used, and the wound environment thus gets exposed to gloves. The aim of this study was to characterize secretion of MMPs and tissue inhibitors of metalloproteinases (TIMPs) in cultured fibroblasts with or without exposure to gloves. Cultures were exposed to glove washings from powdered or powder-free latex examination gloves and compared to untreated controls. MMP-1, -2, -3, -9 and their inhibitors TIMP-1 and -2 were assayed in conditioned media. Cells exposed to gloves reduced their release of MMP-1, -2, and -3 with no differences between the manufacturers of the gloves. The inhibitor TIMP-1 was reduced to 10-15% of untreated control values (p < 0.001), being less affected by the powder-free than by the powdered glove (p < 0.05). MMP-9 and TIMP-2 were not significantly altered. We therefore conclude that secretion of MMPs and TIMPs from cultured fibroblasts were affected by glove washings. Powdered and powder-free gloves had similar effects, except for a less pronounced reduction of TIMP-1 production by the powder-free glove. Examination gloves might therefore affect wound healing, with the least pronounced effect observed using the powder-free glove.

Surgical Scrub and Skin Disinfection

The role of pre-operative disinfection of the surgeon's hands and the skin of the operative site in the prevention of wound infection remains uncertain. The normal resident skin flora, consisting mainly of coagulase-negative staphylococci and aerobic and anaerobic diphtheroids, is an uncommon cause of infection except in prosthetic operations. Staphylococcus aureus is rarely a resident on normal skin other than the perineum, and is mostly present on the hands as a transient acquired from the nose. Nevertheless, it seems rational to kill or remove all transients on the hands of the surgeon and reduce residents to low levels. Surgical skin disinfection is usually assessed by measuring the reduction in organisms on the hands immediately after disinfection, after repeated applications of the disinfectant and after wearing gloves for two to three hours. The hands are commonly sampled in a bowl or plastic bag containing Ringer's or a similar solution and relevant neutralizers, or by the use of glove washings. A standardized technique is necessary to provide a statistical comparison between agents. Antiseptic detergents, chlorhexidine or povidone iodine show immediate reductions in bacterial counts of 70% to 80%, increasing to 99% after repeated application. Hexachloraphene and triclosan detergents show a lower immediate reduction but a good residual effect. Seventy percent ethyl or 60% propyl alcohol, with or without an antiseptic, show an immediate reduction of over 95%, and in excess of 99% on repeated application. Residual levels of organisms tend to be lower after repeated alcohol treatment than following the use of antiseptic detergents.(ABSTRACT TRUNCATED AT 250 WORDS)